Measures to cut hours to less than 65 a week effective in small public hospitals

Reforms to cut public doctors' working hours to less than 65 a week were more effective in small hospitals, but some frontline staff were still resistant to a change in duty patterns, the Hospital Authority said.

The authority's steering committee on doctors' work reform met last Monday to discuss the first-year progress of the trial and concluded that it was 'effective to certain extents'.

The authority launched the HK$108 million reform in November last year at pilot hospitals, aiming to cut doctors' weekly working hours to less than 65 by the end of next year.

Authority director for cluster services Cheung Wai-lun said that the three new measures - extra operating time in the evening, new emergency wards to reduce hospital admissions and 24-hour availability of technicians to support doctors - had 'a bigger impact on small and less busy hospitals'.

For example, general and orthopaedic surgeons at Yan Chai and North District hospitals did not have to be on night duty so frequently. Their hours had been cut from between 70 and 80 a week to 65. Both were smaller, 'secondary' hospitals.

Doctors at busy 'tertiary' hospitals, however, did not have a similarly significant cut in their work hours because their night shifts could not be cut, amid high demand from urgent cases.

'It is premature to say if the reform is successful or not,' Dr Cheung said. 'It is a good start and we are in the right direction. There is still a cultural resistance to the change among frontline staff.'

Four pilot hospitals have an extra evening surgery session. Their use of emergency operating time at night had dropped between 14 per cent, at United Christian Hospital, and 45 per cent, at Yan Chai.

'United Christian Hospital is a very busy acute hospital where surgeons still have to work at night for urgent operations, while Yan Chai Hospital can place fewer doctors at night, after the evening operation sessions clear some cases,' Dr Cheung said.

Three hospitals have set up special emergency wards to treat patients from the accident and emergency rooms. The wards are aimed at treating patients promptly and discharging them without admitting them to the wards of different specialities. The three hospitals have cut down acute-patient days by between 3 per cent and 26 per cent as a result.

Six hospitals have also introduced 24-hour service by technical-services assistants to take over some simple duties of doctors, including blood taking, electrocardiogram recording and intravenous cannulation.

The work of the 110 assistants has saved 11,000 doctor hours per month, which is equivalent to the workload of about 60 doctors.

'This is the most effective measure and it is welcomed by all doctors,' Dr Cheung said. 'We will surely introduce measures to more hospitals.'

He said the reforms were not only about cutting doctors' work hours but also enhancing patient care.

'What we can see is that patients receive quicker treatment at the emergency wards and they wait for a shorter time for an operation at night because of the extra operating time added,' he said.

While some doctors now have to work non-stop for more than 30 hours, the authority also wants to gradually reduce the continuous work hours to 16 on weekdays and 24 at weekends and public holidays. But the authority has no timetable for achieving these targets.

Cause and effect

The three new measures to cut public doctors' working hours and their interim results:

Introduction of new evening operation sessions at four hospitals.

Emergency operating time, between 10pm and 8am, cut by 14 per cent to 45 per cent.

Setting up of emergency wards at three hospitals.

Acute patient days cut by 3 per cent to 26 per cent; admission to internal medicine department cut by 6.5 per cent; patient survey finds 91 per cent think the service has improved the quality of care.

Introduction of 24-hour technical services assistants at six hospitals.